Type 2 Diabetes

Type 2 Diabetes

1. Etiology

   • Pancreas doesn't produce enough insulin
     • Risk Factors
       • Genetics
         • Mutations
           • Lead to insulin resistance
       • Autoimmune
       • Viral
       • Environmetnal
       • Obesity
       • Metabolic Syndrome
         • Characterized by insulin resistance
           • Elevated insulin lelves,
     • Some insulin still produced
       • Strain on Pancreas to produce insulin
         • Leads to type 1
   • People over 35
     • Gradual Onset
   • Inappropriate glucose production from liver
     • Livers response of regulating glucose = haphazard
   • Alteration in the Production of hormones/apidokines
     • Involved in glucose/fat metabolism
       • Adiponectin/Leptin

2. Signs/Symptoms

   • Fatigue
   • Recurrent Infection
   • Prolonged Wound Healing
   • Visual Changes

3. Diagnosis

   • AIC
     • Tells you glucose levels over its lifespan
       • >6.5%
   • Fasting Plasma Glucose
     • >7mmol/L
   • Random/Casual Plasma Glucose
     • >11mmol/L
   • 2 hour OGTT
     • Sugary Orange Drink
       • >11.1mmol/L

4. Drug Therapy

   • Insulin if can't control BG by other means
     • Rapid Acting (Bolus)
       • 0-15 mins before meal
         • Onset: 10-15 mins
           • Lispro, Aspart, Glulisine
     • Short Acting (Bolus)
       • Injected 30-45 mins before meal
         • Onset: 30-60 mins
           • Humulin-R
     • Long Acting (Basal)
       • Injected once daily before bed
         • Released steadily, no peak action
           • Cant be mixed, clear/colourless
             • Glargine(lantus), Detemir (Levemir)
   • Oral Agents
     • Must have circulation of endogenous insulin
       • Insulin resistance
       • Decreased Insulin production
       • Increased hepatic glucose production
     • Sulphonylureas
       • Increase insulin production @ pancreas
       • Decrease chance of prolonged hypoglycaemia
       • Gliclazide/Glimepride
     • Meglitinides
       • Increase insulin production from pancreas
         • Taken 30 mins before each meal
         • More rapidly absorbed/eliminated
           • Reduced hypoglycaemia potential
       • Repaglinide (GlucoNorm)
       • Nateglinide (Starlix)
     • Biguanides
       • Reduce glucose production by liver
         • Enhance insulin senstitivity @ tissues
           • Metformin
     • Alpha-Glucosidase Inhibitors
       • Slow down absorption of carbs
         • Taken with first bite of each meal
           • Acarbose (Glucobay)
     • Thiszolidinediones
       • Improve insulin sensitivity, transport, utilization @ tissues
         • Don't increase insulin production
         • Pioglitazone (Actos)/Rosiglitazone (Avandia)

5. Nutritional Therapy

   • Achieving glucose, lipid, and BP goals
   • Calorie Reduction
     • Increase Fibre

6. Exercise

   • Increases insulin receptor sites/sensitivity
     • Lowers BG levels
   • Contributes to weight loss
     • Decreases insulin resistance
   • 150 mins moderate intensity aerobic activity
     • Glucose lowering lasts 48 hours after activity
   • Small carb snacks eaten every 30 mins

7. Complications

   • Hyperosmolar hyperglycemia syndrome
     • Life threatening
       • Older th60an
     • Circulating insulin that doesn't prevent severe hyperglycaemia
       • Osmotic diuresis
         • Extracellular fluid depletion
       • BG >23mmol/L
       • Absent/minimal ketone bodies
     • Management
       • Clients blood/urine tests
       • IV for dehydrations
       • Insulin to reduce BG
       • Monitor for signs for potassium imbalance